Behavior Training Reduces Incontinence In Prostatectomy Patients, Study Shows

Ted Johnson M.D., M.P.H.

News Article ImageWhile a program including pelvic floor muscle training, fluid management and bladder control strategies was effective, the addition of computer-assisted biofeedback and pelvic floor electrical stimulation provided no additional benefit, according to the study.  

The researchers, including Theodore Johnson II, MD, MPH, Atlanta Veterans Affairs Medical Center researcher and Emory School of Medicine professor of medicine and associate professor of urology, found that behavioral therapy improved the effects of incontinence on daily activities and condition-specific quality of life. Johnson, who is also director of the Emory Center for Health and Aging, led the team at the Atlanta VA Medical Center site, which contributed participants to the study.   

Under the leadership of Patricia Goode, MD, lead investigator from the Birmingham VA and the University of Alabama- Birmingham, the authors conducted the study to evaluate the effectiveness of behavioral therapy for reducing persistent post-prostatectomy incontinence and to determine whether the technologies of biofeedback and electrical stimulation enhance its effectiveness.  

The randomized controlled trial, which involved 208 community-dwelling men ages 51 through 84 years with incontinence persisting 1 to 17 years after radical prostatectomy, was conducted from 2003 – 2008 and included a one-year follow-up after active treatment. Twenty-four percent of the men were black and 75 percent were white.  

“Urinary incontinence following prostate cancer surgery can be very distressing and bothersome to men, even though they are thankful to be cured of cancer,” says Johnson.  “For those men who continue to have urine leakage – this exercise and behavior therapy could help them meaningfully reduce their total number of accidents, even if they have had their incontinence for years following surgery.”  

A radical prostatectomy is a surgery to remove the prostate gland and some of the tissue around it.  Radical prostatectomy is most often used if testing shows that the cancer has not spread outside the prostate (stages I and II) and can be completely removed for cure.  

According to researchers, men in the United States have a one in six lifetime prevalence of prostate cancer. Although survival is excellent, urinary incontinence is a significant morbidity following radical prostatectomy, often the treatment of choice for localized prostate cancer. Patient surveys indicate that as many as 65 percent of men continue to experience incontinence up to five years after surgery. Loss of bladder control can be a physical, emotional, psychosocial and economic burden for men who experience it.  

The researchers found that over an eight-week treatment period, those in the behavioral therapy group had an average reduction of incontinence episodes of 55 percent (from 28 to 13 episodes per week), which was a significantly greater percent reduction than that reported by the control group (average reduction of 24 percent; from 25 to 21 episodes per week). Those in the behavior-plus group experienced an average reduction of 51 percent (from 26 to 12 episodes per week), indicating that the addition of biofeedback and electrical stimulation did not improve eight-week results compared with behavioral therapy alone.  

Improvements were evident up to a year later in the active treatment groups, which showed a 50 percent reduction in the behavioral group and 59 percent reduction in the behavior plus group. And by the end of the treatment period, 15.7 percent of men in the behavior therapy group, 17.1 percent in the behavior-plus group, and 5.9 percent in the control group achieved complete continence, reporting no incontinence episodes in their 7-day bladder diaries.


The Robert W. Woodruff Health Sciences Center of Emory University is an academic health science and service center focused on missions of teaching, research, health care and public service. Its components include the Emory University School of Medicine, Nell Hodgson Woodruff School of Nursing, and Rollins School of Public Health; Yerkes National Primate Research Center; Winship Cancer Institute of Emory University; and Emory Healthcare, the largest, most comprehensive health system in Georgia. Emory Healthcare includes: The Emory Clinic, Emory-Children’s Center, Emory University Hospital, Emory University Hospital Midtown, Wesley Woods Center, and Emory University Orthopaedics & Spine Hospital.  The Woodruff Health Sciences Center has a $2.5 billion budget, 17,600 employees, 2,500 full-time and 1,500 affiliated faculty, 4,700 students and trainees, and a $5.7 billion economic impact on metro Atlanta.